Register Child's Full Name* Age* Grade* Email* Emergancy Contact* Emergancy Contact Phone Number*Event You Are Registering For*Pinewood DerbyAllergies/Medical Conditions* Consent* I agreeI understand that participation in the above Activity or Event may be hazardous for the above-named participant. I, THE PARENT OR GUARDIAN, ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS OCCURANCE, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. It is understood that the activity will include the use of hand tools and power tools, which carry inherent risk. By filling out this online form, I assume risk of harm or injury which may occur to the participant as a result of participating in the above-named event or activity. I hereby release Kona Vocational and/or Big Island Baptist Church and its officers, employees, or agents from any liability, costs and damages resulting from this individual's participation. If the participant is a minor: I agree that the minor has my consent to participate in the event or activity. I also give my consent for the business or organization to seek emergency treatment for the minor if necessary, and I agree to accept financial responsibility for the costs related to this emergency treatment.Photo Consent I agree (Optional)I AGREE to allow my child’s photo, video, or film likeness to be used for any legitimate purpose by Kona Vocational and/or Big Island Baptist Church.Registration Fee Price: Address* Street Apartment Number (if applicable) City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card*Card Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.